Recurrent Abscesses Research Articles

Unusual presentation of bezoars and foreign body insertion in the breast as a self-harm behavior: a case report

Introduction and importance: Although they are uncommon, self-inflicted foreign bodies in the breast pose special care difficulties. Since underlying psychological issues are frequently linked to these instances, early detection and a multidisciplinary approach are necessary to improve results. Case presentation: Over the course of four to five months, a 28-year-old mother developed recurring breast abscesses and draining sinuses. An ultrasound showed a cord-like structure with fluid accumulation in the right breast, and CT imaging identified the foreign matter as a broken safety pin. Saline irrigation and surgical excision were carried out. Bipolar disorder was diagnosed during a meeting with a psychiatrist. Other foreign objects, such as two hair tufts and a broken needle, were found during follow-up and extracted under local anesthetic. Because the patient did not take their psychiatric medication as prescribed, they were lost to follow-up. Clinical discussion: Patients with unexplained breast complaints or recurrent abscesses should be evaluated for self-inflicted foreign bodies. This instance emphasizes the value of a multidisciplinary strategy that addresses the psychological as well as the physical aspects of self-harm by combining psychiatric treatment with surgical intervention. Conclusion: Physicians need to be on the lookout for self-inflicted foreign bodies, especially in patients who have inconsistent medical histories or mental health conditions. Improving patient outcomes requires early discovery and thorough treatment, which includes psychological support.

Risk factors for perianal abscess recurrence after incision and drainage: a review of the literature

Perianal abscesses are a commonly managed condition by general surgery, usually with antibiotics and an incision and drainage in the operating theatre. They are estimated to recur 30% of the time. This literature review was performed is to investigate risk factors for recurrence for perianal abscess. The 19 pertinent studies were included, which revealed that inflammatory bowel disease and abscess location have been repeatedly shown to be risk factors for recurrence of perianal abscess. There were numerous other risk factors including diabetes, smoking, patient age and gender, and pre-operative fever that were discussed in the literature but were not consistently between studies shown to be significant.

P0776 EVOKE - Evaluation of the long-term outcomes of Crohn’s disease complicating intra-abdominal abscess - retrospective, multicentre cohort study

Abstract Background Crohn’s disease (CD) complicated with intra-abdominal abscess often requires surgical intervention. Image guided percutaneous drainage (PD) can help to avoid surgical interventions, however there is limited evidence on the optimal management after PD. Our study aimed to analyze the long-term outcomes of CD complicated with intra-abdominal abscess after intervention. Methods In this multicenter, multinational retrospective trial penetrating CD patients with simplex intra-abdominal abscess were enrolled and followed. Baseline was defined as the day of the first detection of simplex abdominal abscess, while follow-up period of 12-24 months was set. Patients with urgent resection were excluded. Patients were grouped based on elective surgical need during follow-up after a successful PD, while a control group of patients after resection without PD is created. Primary outcome was the abscess recurrence, while stoma rate, post procedural complications rate (<30 days), and postoperative luminal recurrence were analyzed as secondary outcomes. Logistic regression and Cox-regression models were created, while descriptive statistics, Welch’s test, and Fisher’s exact test were used to compare groups, with p-values <0.05 considered significant. Results A total of 131 CD patients from 7 countries were recruited (Table 1., 58% were male, the median age at inclusion was 31.4 [IQR25-40] years) and 74/131 patients had PD due to simplex abdominal abscess during a median follow-up of 104 (74-104) weeks. Abscess recurrence rates did not differ between groups (p=0.155, Figure 1.); however baseline SES-CD score was coupled with increased risk of recurrence (HR=1,17, 95% CI 0.993-1.389). Need for re-drainage was more common amongst PD patients (OR=0.092, 95% CI=0.012-0.732), while new stoma was created more frequently in patients without prior PD (OR=2.50, 95% CI=1.034-6.034). Postoperative luminal recurrence was similar between groups based on PD. Surgical complications were coupled with increased odds in patients without prior PD (OR=8.609, 95% CI=1.825-40.616), septic complications, perforation and new fistula formation were reported the most, while PD associated complication did not occur. Conclusion However, abscess recurrence did not differ between groups, PD prior to surgery strongly correlated with less stoma creature. Furthermore, surgical treatment of intra-abdominal abscess alone may be coupled with post procedural complications.

Etiology, Risk Factors, and Antimicrobial Resistance in Recurrent Pyogenic Liver Abscesses: A Six-Year Analysis.

To perform a comparative analysis of the clinical data of patients with and without recurrent pyogenic liver abscess and explore the influencing factors, clinical characteristics, and pathogenic bacteria associated with the recurrence of liver abscesses. A retrospective analysis was conducted on 436 recently diagnosed patients with pyogenic liver abscess admitted to the Affiliated Hospital of Chengde Medical College between June 2017 and June 2023. Patients with recurrence comprised the observation group, whereas those without recurrence comprised the control group.This analysis included the examination of clinical characteristics, pathogens, drug resistance patterns, and treatment modalities. Additionally, regression analysis was employed to investigate the factors influencing liver abscess recurrence. Of 436 patients initially diagnosed with pyogenic liver abscess, 58 experienced recurrence. The proportion of Escherichia coli infection was 23.3% in the observation group and 10.3% in the control group, indicating a statistically significant difference. Multivariate analysis identified diabetes mellitus and cerebral infarction as significant risk factors for recurrent pyogenic liver abscess. In comparison with patients without recurrence, those who experienced recurrent pyogenic liver abscess following initial diagnosis exhibited a higher prevalence of E. coli as a pathogenic bacterium. In addition, a history of diabetes mellitus and cerebral infarction are high-risk factors for with pyogenic liver abscess recurrence for the first time.

Persistent Peril: Confronting Recurrent Chest Abscess from Nontuberculous Mycobacteria

Abstract Recurrent chest wall abscesses, particularly those caused by nontuberculous mycobacteria (NTM) such as Mycobacterium fortuitum, are uncommon and pose significant diagnostic and therapeutic challenges. Our case report details a 42-year-old male with recurrent chest wall abscess, where the underlying etiology was traced to a near-drowning incident at the age of 18. Near-drowning incidents can lead to the aspiration of contaminated water, allowing waterborne pathogens, including NTM to enter the body and establish chronic infections. It also underscores the importance of considering environmental exposure in the pathogenesis of NTM infections and highlights the need for a multidisciplinary approach to effectively manage such complex cases.

Looped Penrose Drainages of Acute Hand Infections in Vulnerable Populations.

Acute hand infections (AHIs) remain a challenge for hand surgeons and represent a condition for which clinical outcomes are considerably affected by social barriers. We previously described the looped Penrose drainage technique, where a drain is sutured to itself in a loop and the outflow tract of egress is maintained, thus obviating the need for large incisions, wound closure, or repeat packing, thereby reducing the follow-up burden. In the face of escalating numbers of socioeconomically vulnerable patients, especially in urban settings, we aimed to characterize the clinical features and outcomes of this technique in an urban population of patients with AHI. A review of all surgical irrigations of AHI by a single, fellowship-trained hand surgeon at an urban hospital from 2013 through 2021 was performed. Patient demographics, procedure details, and postprocedure outcomes were analyzed. Fifty-three patients (average age, 48.6 years) with AHI underwent surgical irrigations with the looped Penrose drainage technique. The majority of patients were Black (50.9%). Approximately 81.1% of the patients received public insurance, 22.6% were unemployed, 35.9% had annual incomes <$40,000, and 17% experienced homelessness. Overall, 34% were lost to follow-up with the Penrose still intact, including 78% of those who were homeless. Most of the cases occurred on the hand, with involvement of the deep spaces (24.5%), tenosynovitis (39.3%), and bone (1.9%). Recurrent infection (1.9%) and abscess formation (5.7%) led to one reoperation (1.9%). There were no amputations or readmissions, and all postoperative emergency department visits (7.1%) were discharged. The looped Penrose technique is a simple and less invasive alternative to traditional incision and drainage with packing and serves as an effective single-episode intervention strategy for AHIs, particularly in patients with complex social challenges because of the ease of wound management and low rates of readmission and reoperation. Therapeutic IV.

Management of pilonidal sinus and recurrences in 2025.

Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.

The influence of hormonal combined contraceptive in the onset of hidradenitis suppurativa: a retrospective cohort study.

Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease characterized by recurrent painful nodules, abscesses and sinus tract on the apocrine gland-bearing skin. The role of sex hormones in the pathogenesis as well as the use of hormonal treatment in the management of HS is still debated. We performed a retrospective cohort study including 183 patients to assess the influence of combined estrogen-progestin oral contraceptive (COC) in HS onset and disease severity. Univariable and multivariable analyses highlighted that the patients undergoing COC therapy had a later onset of HS, more precisely 9 years after the patients who have not received COC, independently to body mass index, family history, smoking, acne, age of menarche, and concomitant gynecological disorders. This study suggests that COC use could influence the development and the progression of HS and supports the key role of sex hormones in the pathogenesis of the disease.

Enhancing Hidradenitis Suppurativa Assessment: The Role of Ultra-High Frequency Ultrasound in Detecting Microtunnels and Refining Disease Staging.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting hair follicles, causing recurrent abscesses and nodules in intertriginous regions. The International HS Severity Score System (IHS4) is widely used to assess HS severity by counting inflammatory nodules, abscesses, and draining fistulas/tunnels. However, traditional clinical examinations may underestimate HS severity due to the presence of subclinical lesions. This study aims to enhance the accuracy of HS severity assessment by incorporating ultra-high frequency ultrasound (UHFUS) to detect subclinical lesions, such as microtunnels. A cohort of 122 patients with HS (75 females and 47 males) was evaluated. Clinical severity was assessed using the IHS4 scoring system. UHFUS assessments were performed using a 70 MHz probe for patients with mild and moderate IHS4 scores. Statistical tools were used to assess the significance of UHFUS in detecting additional lesions not identified during clinical examinations. The study found that 23% of patients had mild HS, 58.2% had moderate HS, and 18.9% had severe HS according to IHS4. Among the 28 patients with mild IHS4, 14 had microtunnels detected by UHFUS, leading to a change in disease staging: 11.5% of patients were reclassified as mild, while 69.7% were reclassified as moderate. A statistically significant difference in the distribution of severity classifications before and after UHFUS examination was observed (χ2 = 5.11, P = .0238). The study underscores the critical role of UHFUS as a non-invasive technique for the precise assessment of HS. The integration of UHFUS with a 70 MHz probe significantly enhances the detection of subclinical lesions, such as microtunnels, enabling timely intervention and potentially preventing disease progression. Despite the study's limitations, including its monocentric design and small sample size, the findings support the use of UHFUS in improving the accuracy of HS severity assessment.

Disease severity assessment in hidradenitis suppurativa: A single-centre cross-sectional study utilising clinical evaluation, high-resolution ultrasound and colour doppler.

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterised by recurrent painful nodules, abscesses, and sinus tract formation in intertriginous areas. Accurate staging of this disorder is crucial for appropriate management and prognosis. The role of imaging in the staging of HS is still evolving. Objective To assess the correlation between clinical disease severity staging and high-resolution ultrasonography and colour doppler (HRUS-CD) staging in HS patients. Design and setting This was a cross-sectional, single-centre study in patients above 18 years of age with the clinical diagnosis of HS. All patients underwent clinical examination and high-resolution ultrasonography and colour doppler study with high-frequency linear probe (L+ 8-24 MHz). Correlations between clinical Hurley staging and the various ultrasonographic parameters i.e. SOS-HS (sonographic staging of severity of HS), degree of vascularisation, fibrotic scarring and oedema were explored and analysed. Spearman's correlation coefficient was applied to study the correlations and p<0.05 was considered significant. Results A total of 46 patients with HS who met the inclusion criteria were included. The majority of patients were clinically in Hurley stages 1 (32.6%; n=15) and 2 (56.5%; n=26) (41 in all). However, on the basis of ultrasonographic findings, significant numbers of patients had greater severity of staging on SOS-HS (58.5%; n=24/41), higher vascularity on colour doppler (26.8%; n=11), more severe grading of fibrous scarring (43.9%; n=18) and oedema (68.2%; n=28) in comparison to the clinical Hurley staging. Limitation Limitations of our study include a small sample size and cross-sectional design. Conclusion The results of the study indicate that the majority of the patients were under-staged and under-treated clinically, hence emphasising the role of high-resolution ultrasonography and colour doppler study in the accurate determination of HS severity. Future research should focus on standardised protocols and larger, prospective studies to establish the role of these imaging modalities in routine clinical practice.

Acute pilonidal abscess: Prospective nationwide audit in the Netherlands.

The aim of this study was to assess Dutch surgical practice and outcomes for acute pilonidal abscess. Patients with pilonidal sinus disease (PSD) who underwent surgical treatment between 1 March 2020 and 1 March 2021 at 36 participating hospitals were included in a prospective observational cohort study. For the present study, only patients with an acute abscess were included for analysis. Outcomes included symptoms, wound healing, time to resume daily activities and complications. Follow-up was 1 year and included questionnaires on recurrent abscesses, symptomatic chronic PSD, quality of life and patient-reported experience measures. Of 681 included patients, 208 presented with an acute pilonidal abscess. Incision and drainage (I&D) was performed in 205 of these patients (99%). The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%. One-year questionnaires were completed by 158 out of 205 patients (77.1%). Fifteen patients (7.3%) had a recurrent abscess within 1 year. The symptomatic chronic PSD rate was 8.8%. Of all the patients presenting with PSD in this prospective national study cohort, 30% had a pilonidal abscess. Incision and drainage showed a low complication rate but successful wound healing in less than half of the patients. The study showed that 91.2% of patients did not undergo additional surgical treatment for symptomatic chronic PSD within 1 year of follow-up.

Recurrent Primary Nocardia Brain Abscess (Nocardia farcinica) in an Immunocompetent Patient with a History of Non-Nocardial Multi-Systemic Infection

Recurrent Primary Nocardia Brain Abscess (Nocardia farcinica) in an Immunocompetent Patient with a History of Non-Nocardial Multi-Systemic Infection

Avoiding Recurrence of Anorectal Abscess: The Impact of Patient Delay in Seeking Medical Attention

Abstract Objective Anorectal abscess is a frequent surgical problem. The objective of our retrospective study is to determine the clinical factors that mitigate complications of anorectal abscesses. Methods Data from a retrospective review of patients of one colorectal surgeon (GP) admitted and operated on for anorectal abscess at the Jersey Shore University Medical Center and Ocean University Medical Center between January 2019 and December 2022 were reviewed. Clinical information was obtained from medical records. Results A total of 48 patients underwent surgery for drainage of anorectal abscess. After a physical examination, 48% of patients (23 of 48) received diagnostic imaging to confirm the nature and location of the abscess. Approximately 73% of patients (36 of 48) presented with an anorectal fistula upon evaluation. Of the 48 patients, thirty (63%) were diagnosed with a perianal abscess. The abscess in the other 18 of the 48 patients was in other areas of the anorectal region. Eleven patients developed a recurrent abscess after undergoing initial drainage. On average, recurrent patients waited 59 days before seeking initial treatment, whereas nonrecurrent patients waited ∼21 days. Conclusion Patients who delay seeking medical attention are more likely to develop a recurrent abscess after receiving initial treatment. Diagnostic imaging with ultrasound and computed tomography significantly reduced transit time between the emergency room and the operating room. In both recurrent and nonrecurrent groups, no correlation was found between the size or location of the abscess and the chance of abscess recurrence.

Unlocking the Mechanisms of Hidradenitis Suppurativa: Inflammation and miRNA Insights.

Inflammatory skin diseases impose a significant burden on patients and healthcare systems worldwide. Among these, hidradenitis suppurativa (HS) is particularly notable for its chronic and recurrent nature. Recurrent nodules, abscesses, and scarring in apocrine gland-rich areas characterize the disease, including the groin, axillae, and perianal regions. Despite its considerable physical and psychological impact, the precise mechanisms driving HS remain elusive. Recent advancements in understanding the inflammatory processes involved in HS have highlighted the TNF-alpha, IL-1β, and IL-17/IL-23 pathways, which play crucial roles in initiating and perpetuating the disease. Moreover, specific microRNAs (miRNAs), such as miR-24-1-5p, miR146a-5p, mirR-26a-5p, miR-206, miR-338-3p, and miR-338-5p, are involved in these inflammatory processes. Dysregulation of these miRNAs contributes to aberrant cytokine expression and persistent inflammation, foreseeably exacerbating HS disease progression. This narrative review hypothesizes that miRNA dysregulation triggers aberrant expression in specific inflammatory pathways, contributing to HS's clinical manifestations and progression. We explore the implicated miRNAs' potential as biomarkers for earlier disease detection and as novel therapeutic targets. Identifying miRNA dysregulation offers new opportunities for earlier and more accurate diagnosis, potentially allowing clinicians to intervene before severe disease manifestations occur. Furthermore, therapeutic strategies to modulate miRNA expression could target the inflammatory pathways driving HS, leading to more personalized and effective treatments. This review also discusses future research directions to enhance the clinical management of HS. A better understanding of miRNA involvement in HS offers new avenues for research and management, ultimately improving patient outcomes and quality of life.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. METHODS In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. RESULTS One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results (P &lt; 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P &lt; 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049–14.458, P &lt; 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090–4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216–5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313–4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203–7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. CONCLUSION The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.

Wound closure techniques after wide excision for hidradenitis suppurativa: a systematic review and meta-analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects intertriginous skin areas, clinically characterized by recurrent inflamed nodules, abscesses, sinus tracts, and severe scars. Systemic treatments may provide temporary relief, while wide surgical excision offers prolonged disease-free periods. We evaluated the most efficient wound closure methods following wide excision of HS lesions in terms of recurrence, functionality, and quality of life. A systematic literature search was conducted in PubMed, Embase, Cochrane, and ClinicalTrials.gov, adhering to the PRISMA 2020 criteria. We included original studies published until February 2024, focusing on wound closure methods post-wide excision for HS. Data from 121 papers were analyzed using network and direct meta-analysis methods to compare recurrence and postoperative complication rates. From 1181 articles, 121 were included in the meta-analysis after removing duplicates and excluding publications that did not meet the inclusion criteria. Recurrence rates were associated with the type of reconstruction technique as follows: primary closure, 25% (95% confidence interval [CI], 20-30%); skin grafts, 18% (95% CI, 14-22%), and flaps, 12% (95% CI, 9-15%). Secondary intention healing showed a recurrence rate of 28% (95% CI, 23-33%). Flaps were associated with the lowest recurrence rates compared to other surgery techniques.

High incidence of complications following intraoral extractions and treatment of periapical infections in the management of domestic rabbit (Oryctolagus cuniculus) dental disease (51 cases).

To describe the outcome of common medical therapies, intraoral dental procedures, extraoral surgical interventions, and resulting complications of treatment in client-owned rabbits diagnosed with dental disease. The medical records of 51 client-owned domestic rabbits presenting for veterinary care and management of dental disease from 2013 to 2023 at 2 veterinary teaching hospitals were reviewed. Of the patients managed with coronal reduction and occlusal adjustment, none developed significant complications. Of the patients that required intraoral dental extractions, 41% developed postprocedural complications, including incomplete tooth extraction. Following periapical infection and the formation of an odontogenic abscess for which surgical intervention was implemented, 25% of patients developed complications, including abscess recurrence and sepsis. Meloxicam was the most frequently prescribed analgesic medication for all procedures reviewed. Trimethoprim-sulfamethoxazole combination oral suspension was the most frequently prescribed antibiotic following coronal reduction, occlusal adjustment, and dental extractions, and parenteral penicillin G procaine was the most frequently prescribed antibiotic following periapical infection-related interventions. Seven patients had documentation of natural death or humane euthanasia secondary to progressive dental disease. The risk of postprocedural complications during the management of dental disease must be considered and discussed given the high rate of potential complications. With the increasing popularity of rabbits as companion animals, dental disease is considered one of the most common reasons for veterinary care in this species. Rabbits undergoing intraoral dental procedures and extraoral surgical interventions for the treatment of acquired and progressive dental disease are at risk of developing adverse postprocedural sequelae that must be considered before attempting intervention. This report adds to the growing body of scientific literature related to the management of this challenging disease process.

A large cohort from an immunology reference center and an algorithm for the follow-up of chronic neutropenia.

Chronic neutropenia causes involve nutritional deficiencies and inborn errors of immunity(IEI), such as severe congenital neutropenia. To classify common chronic neutropenia causes in a pediatric immunology unit. We enrolled 109 chronic neutropenia patients admitted to a pediatric immunology department between 2002-2022. We recorded clinical/laboratory features and genetic characteristics. The male/female ratio was 63/46. Fifty-eight patients had parental consanguinity(57.4%). 26.6% (n = 29) patients had at least one individual in their family with neutropenia. Common symtpoms at presentation were upper respiratory tract infections(URTI)(31.1%), oral aphthae(23.6%), skin infections(23.6%), pneumonia(20.8%), and recurrent abscesses(12.3%). Common infections during follow-up were URTI(56.8%), pneumonia(33%), skin infections(25.6%), gastroenteritis(18.3%), and recurrent abscesses(14,6%). Common long-term complications were dental problems(n = 51), osteoporosis(n = 22), growth retardation(n = 14), malignancy(n = 16)[myelodysplastic syndrome(n = 10), large granulocytic leukemia(n = 1), acute lymphoblastic leukemia(n = 1), Hodgkin lymphoma(n = 1), EBV-related lymphoma(n = 1), leiomyosarcoma(n = 1), and thyroid neoplasm(n = 1)]. We performed a genetic study in 86 patients, and 69(71%) got a genetic diagnosis. Common gene defects were HAX-1(n = 26), ELA-2 (ELANE)(n = 10), AP3B1(n = 4), and ADA-2(n = 4) gene defects. The IEI ratio(70.6%) was high. GCSF treatment(93.4%), immunoglobulin replacement therapy(18.7%), and HSCT(15.9%) were the treatment options. The mortality rate was 12.9%(n = 14). The most common long term complications were dental problems that is three times more common in patients with known genetic mutations. We prepared an algorithm for chronic neutropenia depending on the present cohort. An important rate of inborn errors of immunity, especially combined immunodeficiency(11.9%) was presented in addition to congenital phagocytic cell defects. Early diagnosis will allow us tailor the disease-specific treatment options sooner, preventing irreversible consequences.

Recurrent peritonsillar abscess in adults: Incidence and risk factors in a prospective longitudinal cohort

ObjectiveThe incidence of recurrent peritonsillar abscess (7.4–22%) was estimated in retrospective studies. The aim of this prospective study was to estimate the cumulative incidence of recurrent peritonsillar abscess and related risk factors. MethodsWe performed a prospective longitudinal cohort study. The study included adult patients (≥18 years old) of both sexes who were attended in the emergency facilities of our tertiary hospital, without peritonsillar abscess background, diagnosed of a first episode of peritonsillar abscess and treated with standard of care (abscess drainage and antibiotics). Patients were followed for 24 months. Cumulative incidence of peritonsillar abscess recurrence was estimated and its 95% confidence interval was calculated; and predictive risk factors were assessed. ResultsBetween January 1st, 2019 and March 9th, 2020, a total of 181 consecutive patients were included. The cumulative incidence of recurrent peritonsillar abscess at 2 years of the diagnosis was 9.9% (18 out of 181, 95% CI: 6.4–15.2%). The only risk factor associated with recurrent peritonsillar abscess in multivariate analysis was low plasma glucose level at the time of emergency room attendance (HR: 0.46, 95% CI: 0.24–0.91, p-value: 0.026). ConclusionPeritonsillar abscess is an incident medical issue, with an established recurrence rate, but with unclear predictive risk factors of recurrence. Further studies are needed to assess the risk factor associated with recurrent peritonsillar abscess.

Severe Deep Fascial Spaces Infections with Pregnancy: A Retrospective Study.

Background: Odontogenic infections are common and self-limiting in most cases, but, they can lead to severe consequences and considerable morbidity and can even be fetal in spite of modern medical therapy. Patients and Methods: Retrospective study included data of pregnant patients with deep fascial space infections, done in Oral & Maxillofacial Surgery Department, Faculty of Dentistry. Alexandria University, and Oral & Maxillofacial Surgery Department, King Fahd Specialist Hospital, Burayda, Qassim, Saudi Arabia, from June2017 to Dec2022. Data were analyzed to study incidence, etiology, pattern, treatment modalities, outcomes, complications, and effects on pregnancy. Results: Thirty-eight pregnant patients, with a mean age of 30.8 ± 6.21 years, were included. The mean age of pregnancy was 24.5 ± 4.3 weeks. Diabetes mellitus was identified in seven cases (18.42%) and combined with hypertension in one case (2.63%) and with valvular heart disease in another one. The commonest affected single space was the submandibular space that occurred in six cases (15.8%). Canine space was the second single commonly involved one which occurred in five patients (13.2%). Complications occurred in 11 patients. Unesthetic scar occurred in three patients (7.9%). Trismus was observed in two patients (5.3%). Recurrent abscess was found in one case. Complications affecting the developing fetus and considered the most serious occurred in four patients: two cases of preterm labor and two cases of abortion. Conclusion: These infections may lead to serious outcomes and may have irreversible effects on the pregnancy and the developing fetus. Urgent intervention with multidisciplinary team to provide adequate care.